益气复脉汤联合左西孟旦治疗老年心力衰竭的临床研究
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摘要
目的:探讨益气复脉汤联合左西孟旦治疗老年心力衰竭的临床疗效。方法:采用随机数字表法将2016年1月—2017年12月收治的168例老年心力衰竭患者分为观察组及对照组,两组均给予常规治疗,包括控制感染及控制血压等,对照组另给予左西孟旦,观察组在对照组的基础上同时给予益气复脉汤。治疗1个月后,对两组患者进行疗效评价。治疗前后,分别检测两组患者超声心动图相关参数[左心射血分数(LVEF)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左室舒张早期与晚期充盈速度比值(E/A)及左房内径(LADD)];检测两组患者心脏功能指标[脑钠肽前体(NT-proBNP)、心胸比、心率、6min步行试验长度(6WMT)]。治疗前后,检测两组患者血清炎性因子[肿瘤抑制因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)及超敏C反应蛋白(hs-CRP)]含量,检测氧化应激指标[谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、丙二醛(MDA)和总抗氧化能力(T-Aoc)]含量。结果:治疗后,观察组总有效率明显高于对照组(P<0.05)。治疗后,观察组各项超声心动图相关参数、心脏功能指标及炎性因子改善程度均明显优于对照组(P<0.05),且GSH-PX、SOD、MDA及T-Aoc的改善程度亦均明显优于对照组(P<0.05)。结论:益气复脉汤联合左西孟旦治疗老年心力衰竭疗效较好,值得进行深入研究。
Objective: To study the clinical efficacy of Yiqi fumai Decoction combined with levosimendan in the treatment of chronic heart failure in elderly patients. Methods: Totally 168 elderly patients with chronic heart failure from Jan. 2016 to Dec. 2017 were randomly divided into observation group(84 cases) and control group(84 cases). The two groups were treated by regular methods including control blood pressure and infection. The control group was given levosimendan while the observation group was treated with Yiqi fumai Decoction. The effects were observed one month after treatment. Before and after treatment, the levels of cardiac function indexes[left ventricular end-diastolic dimension(LVEDD), left ventricular ejection fraction(LVEF), left ventricular end systolic diameter(LVESD), left anterior descending diagonal(LADD) and left ventricular early and late diastolic filling velocity ratio(E/A)], general cardiovascular indexes[cardiothoracic ratio, 6 WMT, pro-brain natriuretic peptide(NT-proBNP) content and heart rate] were detected in the two groups. Before and after treatment, the inflammatory factors(TNF-α, IL-1, IL-6 and hs-CRP), oxidative stress index(GSH-PX, SOD, MDA and T-Aoc) were observed in the two groups. Results: After treatment, the total effective rate of observation group was significantly higher than that of the control group(P<0.05). After treatment, the levels of cardiac function indexes and general cardiovascular indexes were significantly promoted in observation group than those of the control group(P<0.05). After treatment, TNF-α, IL-1, IL-6 and hs-CRP levels were significantly lower, while the levels of GSH-PX, SOD, MDA and T-Aoc were significantly higher in the observation group than those of the control group(P<0.05). Conclusions: Yiqi fumai Decoction combined with levosimendan in the treatment of chronic heart failure in elderly patients has a good clinical efficacy and worth to the next study.
Objective: To study the clinical efficacy of Yiqi fumai Decoction combined with levosimendan in the treatment of chronic heart failure in elderly patients. Methods: Totally 168 elderly patients with chronic heart failure from Jan. 2016 to Dec. 2017 were randomly divided into observation group(84 cases) and control group(84 cases). The two groups were treated by regular methods including control blood pressure and infection. The control group was given levosimendan while the observation group was treated with Yiqi fumai Decoction. The effects were observed one month after treatment. Before and after treatment, the levels of cardiac function indexes[left ventricular end-diastolic dimension(LVEDD), left ventricular ejection fraction(LVEF), left ventricular end systolic diameter(LVESD), left anterior descending diagonal(LADD) and left ventricular early and late diastolic filling velocity ratio(E/A)], general cardiovascular indexes[cardiothoracic ratio, 6 WMT, pro-brain natriuretic peptide(NT-proBNP) content and heart rate] were detected in the two groups. Before and after treatment, the inflammatory factors(TNF-α, IL-1, IL-6 and hs-CRP), oxidative stress index(GSH-PX, SOD, MDA and T-Aoc) were observed in the two groups. Results: After treatment, the total effective rate of observation group was significantly higher than that of the control group(P<0.05). After treatment, the levels of cardiac function indexes and general cardiovascular indexes were significantly promoted in observation group than those of the control group(P<0.05). After treatment, TNF-α, IL-1, IL-6 and hs-CRP levels were significantly lower, while the levels of GSH-PX, SOD, MDA and T-Aoc were significantly higher in the observation group than those of the control group(P<0.05). Conclusions: Yiqi fumai Decoction combined with levosimendan in the treatment of chronic heart failure in elderly patients has a good clinical efficacy and worth to the next study.
引文
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[7] 杨柳. 益气养阴活血方加减对老年充血性心力衰竭患者血清脑钠肽、内皮素及降钙素原水平影响研究 [J]. 中华中医药学刊, 2017, 35(8): 2203-2205.
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[11] 陈武君, 黄火剑, 庄洪标. 中药封包辅助治疗对慢性心力衰竭患者心功能及生活质量的影响 [J]. 中华中医药学刊, 2018, 36(3): 729-731.
[12] Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients withchronic heart failure [J]. Eur J Cardiovasc Nurs, 2015, 14(4):310-316.
[13] Russell EA, Tran L, Baker RA, et al. A review of outcome following valve surgery for rheumatic heart disease in Australia [J]. BMC Cardiovasc Disord, 2015, 15:103.
[14] Koshy A, Pellicori P, Clark AL. The effect of increasing inspired oxygen on exercise performance in patients with chronic heart failure [J]. Heart, 2016, 102(8):597-601.
[15] 任阳, 谢圆媛. 芪苈强心胶囊联合托拉塞米片治疗老年原发性高血压合并心力衰竭的效果及安全性 [J]. 中国医药导报, 2016, 13(33): 153-156.
[16] 刘伟, 杨宁, 王妮. 芪参益气滴丸、双嘧达莫联合替罗非班治疗非ST段抬高型急性冠脉综合征的效果与安全性 [J]. 中国医药导报, 2016, 13(29): 127-131.
[17] 马金, 张艳. 慢性心力衰竭中医病机“气虚-血瘀-水停”与“心室重构”的相关性探讨 [J]. 现代中西医结合杂志, 2016, 25(17): 1936-1938.
[18] 马文欢, 陈丽云, 郭美珠, 等. 严世芸教授治疗慢性心力衰竭阳虚水泛证中药数据挖据分析 [J]. 中华中医药学刊, 2016, 15(1): 214-217.
[19] 李杨, 陈波, 运峰, 等. 益气温阳、补气健脾法治疗慢性心力衰竭(阳虚水泛型)患者的临床观察 [J]. 中医药信息, 2016, 33(4): 102-104.
[20] 杨柳. 益气养阴活血方加减对老年充血性心力衰竭患者血清脑钠肽、内皮素及降钙素原水平影响研究 [J]. 中华中医药学刊, 2017, 35(8): 2203-2205.
[21] 武俊华, 梁菲菲, 赵晓秋. 温阳活血方加减对慢性充血性心力衰竭患者内皮素及脑利钠肽影响研究 [J]. 山西医药杂志, 2016, 45(3): 12-15.
[22] 冯健宏, 顾健霞. 慢性心力衰竭气虚血瘀证的研究概述 [J]. 中医药临床杂志, 2015, 27(3): 438-441.
[23] 宋光明, 刘丹, 张敏, 等. 从益气活血法论治慢性心力衰竭浅析 [J]. 天津中医药, 2015, 32(8): 466-468.
[24] 孙兰军, 赵英强, 王保和, 等. 强心冲剂治疗慢性充血性心力衰竭(气虚阳虚, 血瘀水停)的机理研究 [C]. 第7次全国中西医结合心血管病学术会议, 2005: 150-159.
[25] 王辰, 张艳, 宫丽鸿, 等. 参草通脉颗粒治疗慢性心力衰竭的多中心随机双盲平行对照研究 [J]. 中国中西医结合杂志, 2012, 32(5): 612-615.
[26] 王拴虎, 毛静远, 侯雅竹, 等. 西药常规加用芪参益气滴丸治疗慢性心力衰竭随机对照试验的系统评价 [J]. 中国中西医结合杂志, 2013, 33(11): 1468-1475.
[27] 戴红. 益气复脉汤对脑缺血再灌注损伤大鼠ET及CGRP影响的实验研究 [J]. 山西中医, 2009, 25(4): 54-55.
[28] 孙卫军. 益气复脉汤配合西医常规治疗病毒性心肌炎40例 [J]. 内科, 2007, 2(6): 928-928.
[29] 张志林, 温玉梅. 参附注射液对慢性心力衰竭炎性因子及心功能的影响 [J]. 吉林中医药, 2016, 36(3): 252-255.
[30] 冯健, 张煜, 曹华明. 瑞舒伐他汀对慢性心力衰竭患者炎性因子、氧化应激及心功能的影响 [J]. 海南医学院学报, 2017, 23(13): 1752-1754.
[2] Allida SM, Inglis SC, Davidson PM, et al. Thirst in chronic heart failure: a review [J]. J Clin Nurs, 2015, 24(7-8):916-926.
[3] Walker AM, Patel PA, Rajwani A, et al. Diabetes mellitus is associated with adverse structural and functional cardiac remodelling in chronic heart failure with reduced ejection fraction [J]. Diab Vasc Dis Res, 2016, 13(5):331-340.
[4] 陈坚, 刘平, 伍君, 等. 急诊集束化治疗急性心力衰竭患者的疗效及对心肺功能的影响 [J]. 中南医学科学杂志, 2016, 44(1): 54-56.
[5] 董洪玲, 王中鲁, 张亮, 等. 慢性心力衰竭的治疗进展 [J]. 中国循证心血管医学杂志, 2017, 9(2): 246-248.
[6] 李楠, 李文杰. 温阳化饮法对老年慢性心衰患者炎性因子及疗效的影响 [J]. 中华中医药学刊, 2017, 35(5): 1104-1106.
[7] 杨柳. 益气养阴活血方加减对老年充血性心力衰竭患者血清脑钠肽、内皮素及降钙素原水平影响研究 [J]. 中华中医药学刊, 2017, 35(8): 2203-2205.
[8] 丁国斌. 益气复脉汤配合西医治疗病毒性心肌炎疗效及对血清心肌酶的影响 [J]. 现代中西医结合杂志, 2016, 25(35): 3959-3961.
[9] 张明惠, 杜新平, 李玉芬. 左西孟旦在难治性心力衰竭中的应用 [J]. 山东医药, 2012, 52(1): 76-77.
[10] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2014[S]. 中华心血管病杂志, 2014, 42(2): 98-122.
[11] 陈武君, 黄火剑, 庄洪标. 中药封包辅助治疗对慢性心力衰竭患者心功能及生活质量的影响 [J]. 中华中医药学刊, 2018, 36(3): 729-731.
[12] Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients withchronic heart failure [J]. Eur J Cardiovasc Nurs, 2015, 14(4):310-316.
[13] Russell EA, Tran L, Baker RA, et al. A review of outcome following valve surgery for rheumatic heart disease in Australia [J]. BMC Cardiovasc Disord, 2015, 15:103.
[14] Koshy A, Pellicori P, Clark AL. The effect of increasing inspired oxygen on exercise performance in patients with chronic heart failure [J]. Heart, 2016, 102(8):597-601.
[15] 任阳, 谢圆媛. 芪苈强心胶囊联合托拉塞米片治疗老年原发性高血压合并心力衰竭的效果及安全性 [J]. 中国医药导报, 2016, 13(33): 153-156.
[16] 刘伟, 杨宁, 王妮. 芪参益气滴丸、双嘧达莫联合替罗非班治疗非ST段抬高型急性冠脉综合征的效果与安全性 [J]. 中国医药导报, 2016, 13(29): 127-131.
[17] 马金, 张艳. 慢性心力衰竭中医病机“气虚-血瘀-水停”与“心室重构”的相关性探讨 [J]. 现代中西医结合杂志, 2016, 25(17): 1936-1938.
[18] 马文欢, 陈丽云, 郭美珠, 等. 严世芸教授治疗慢性心力衰竭阳虚水泛证中药数据挖据分析 [J]. 中华中医药学刊, 2016, 15(1): 214-217.
[19] 李杨, 陈波, 运峰, 等. 益气温阳、补气健脾法治疗慢性心力衰竭(阳虚水泛型)患者的临床观察 [J]. 中医药信息, 2016, 33(4): 102-104.
[20] 杨柳. 益气养阴活血方加减对老年充血性心力衰竭患者血清脑钠肽、内皮素及降钙素原水平影响研究 [J]. 中华中医药学刊, 2017, 35(8): 2203-2205.
[21] 武俊华, 梁菲菲, 赵晓秋. 温阳活血方加减对慢性充血性心力衰竭患者内皮素及脑利钠肽影响研究 [J]. 山西医药杂志, 2016, 45(3): 12-15.
[22] 冯健宏, 顾健霞. 慢性心力衰竭气虚血瘀证的研究概述 [J]. 中医药临床杂志, 2015, 27(3): 438-441.
[23] 宋光明, 刘丹, 张敏, 等. 从益气活血法论治慢性心力衰竭浅析 [J]. 天津中医药, 2015, 32(8): 466-468.
[24] 孙兰军, 赵英强, 王保和, 等. 强心冲剂治疗慢性充血性心力衰竭(气虚阳虚, 血瘀水停)的机理研究 [C]. 第7次全国中西医结合心血管病学术会议, 2005: 150-159.
[25] 王辰, 张艳, 宫丽鸿, 等. 参草通脉颗粒治疗慢性心力衰竭的多中心随机双盲平行对照研究 [J]. 中国中西医结合杂志, 2012, 32(5): 612-615.
[26] 王拴虎, 毛静远, 侯雅竹, 等. 西药常规加用芪参益气滴丸治疗慢性心力衰竭随机对照试验的系统评价 [J]. 中国中西医结合杂志, 2013, 33(11): 1468-1475.
[27] 戴红. 益气复脉汤对脑缺血再灌注损伤大鼠ET及CGRP影响的实验研究 [J]. 山西中医, 2009, 25(4): 54-55.
[28] 孙卫军. 益气复脉汤配合西医常规治疗病毒性心肌炎40例 [J]. 内科, 2007, 2(6): 928-928.
[29] 张志林, 温玉梅. 参附注射液对慢性心力衰竭炎性因子及心功能的影响 [J]. 吉林中医药, 2016, 36(3): 252-255.
[30] 冯健, 张煜, 曹华明. 瑞舒伐他汀对慢性心力衰竭患者炎性因子、氧化应激及心功能的影响 [J]. 海南医学院学报, 2017, 23(13): 1752-1754.